Thoracolumbar Fracture Classification System A New Approach

Spine Trauma Study Group

Alexander R Vaccaro M.D. Professor

Thomas Jefferson University Department of Orthopaedics and the Rothman Institute

Spine Trauma Study Group

Thoracolumbar Classification System

Three Part Description

Fracture Description (Morphometric)

Neurologic Status

Integrity of PLC

Fracture Description (Morphology)

Compression-axial,
flexion,distraction,translation/rotation

Distractionextension,flexion,translation/rotation, compression

Translation/Rotation-flexion,
distraction

Neurologic Status
Intact Nerve Root Injury Cauda Equina Injury Cord Injury-Incomplete, Complete

Posterior Ligamentous Complex

Intact Disrupted In Tension

Treatment
Determined by:

Mechanism Neurology Ligament/ bone Integrity

Mechanism-Point System
Two Component Mechanistic Description

Compression 1 Distraction 3

Translation / Rotation 3

Neurology-Point System
Intact 0 Cauda equina 3

Nerve root
1

Cord
Incomplete 3 Complete 2

Stability-Soft Tissue Point System

Ligaments
Intact 0

PLC
Injured 3

Evaluated by MRI

Stability Spinal Column Point System

Spinal Column

Anterior
1

Posterior
1

Middle
1

Next Step - Direct TX

Assign Points
Conservative Surgery

Point System
Mechanism
Translation/Rotation - 3 Distraction - 3 Compression - 1

Ligament
PLC - 3

Neurology
Cauda equina - 3 Incomplete - 3 Complete - 2 Root - 1

Spinal Column
Anterior - 1 Middle - 1
Posterior - 1

Treatment
Fractures with 4 points or less = non

operative Fractures with 5 points=Nonop vs Op Fractures with 6 points or more = surgery

Examples
Anterior Compression Fx
Compression ( mechanism) - 1 Intact (neurology) - 0 PLC (ligament) no injury - 0 Anterior Column - 1

Total 2 points- Non Op

Example Stable Burst Fracture

Compression (mechanism) - 1 Intact ( neurology) - 0 PLC (ligament) no injury (0) Ant/Middle column 1+1

Total 3 points-Non Op

Example

Unstable Burst-Complete Neuro Injury

Compression (mechanism) -1 Complete (neurology) - 2 PLC (ligament) injury - 3 Ant/Middle column -1+1

Total 8 points-Surgery

Example Stable Burst-Complete injury

Compression-1 Complete neurology-2 PLC Intact-0 Anterior, Middle Column disruption- 1+1

Points 5-Non Op vs Op

Example Fx Dislocation
Translation/rotation - distraction (mechanism) - 3 + 3 Complete (neurology) - 2 PLC (ligament) injury - 3 Anterior column - 1

Total 12 pointsSurgery

Surgically Indicated Patients

Approach Selection
Neurology

Ligament Status

Modifiers

Approach Selection
Neurologically Intact

Ligament Injury present

Posterior alone vs.

Anterior alone vs. Combined

Approach Selection
Neurologically Incomplete

Ligament Injury No

Yes

Anterior

Combined vs

Anterior Modifier Osteoporosis Combined

Approach Selection
Neurologically Complete Injury

Posterior

Thoracolumbar Fracture Classification System

Point system to determine nonoperative vs operative treatment Neurology, ligamentous status helps determine surgical approach Validation necessary

Thank You